Methods and apparatus for acute or chronic delivery of substances or apparatus to extravascular treatment sites

ABSTRACT

Methods and apparatus for delivery of substances or apparatus to target sites located outside blood vessels within the body of a human or animal patient. A vessel wall penetrating catheter is inserted into the vasculature, positioned and oriented within a blood vessel near the target extravascular site and a penetrator is advanced from the catheter so as to penetrate outwardly through the wall of the blood vessel in the direction of the target site. Thereafter, a delivery catheter is passed through a lumen of the penetrator to the target site. A desired substance or apparatus is then delivered to or obtained from the target site. In some applications, the penetrator may be retracted into the vessel wall penetrating catheter and the vessel wall penetrating catheter may be removed, leaving the delivery catheter in place for chronic or continuous delivery of substance(s) to and/or obtaining of information or samples from the target site. Alternatively, a delivery catheter having an occlusion member or balloon may be advanced into a vein or venule and the occlusion member or balloon may be used to occlude the lumen of the vein or venule during and after injection of a substance through the catheter, such that the substance will not be carried away by normal venous blood flow and will remain in the vein or venule for a sufficient period of time to have its intended effect (e.g. to enter adjacent tissues through capillary beds drained by that vein or venule).

BACKGROUND OF THE INVENTION

There exist many situations in which it is desirable to deliversubstances (e.g., drugs, biological materials, etc) or apparatus (e.g.,wires, sensors, etc.) to specific locations within tissues (i.e. an“interstitial target site”) of the body of a human or veterinarypatient. Examples of the types of tissues wherein such target sites maybe located include myocardial tissue, brain tissue or tumors.

Some catheters and drug delivery stents of the prior art have beenpurportedly useable to indirectly deliver drugs or substances tospecific interstitial target locations by first dispensing the drugwithin the lumen of a nearby blood vessel or on the inner surface of anearby blood vessel and then allowing the drug to migrate through theblood vessel wall or through a downstream capillary bed, to the desiredinterstitial target location.

The prior art has also included catheter devices that may be used fordelivering substances or apparatus directly into interstitial targetlocations by guided advancement of a penetrating cannula or needle froma catheter located within the lumen of a nearby blood vessel, throughthe wall of the blood vessel and through any intervening tissue, to theinterstitial target site. The desired substance or apparatus may then beinfused or delivered directly into the target interstitial site withoutany need for transmural diffusion through the blood vessel wall ordownstream transluminal flow to the selected capillary bed. Examples ofthese catheter devices useable for direct delivery of drugs or apparatusinto interstitial target sites are described in PCT International PatentPublications No. PCT/US99/07115 and PCT/US99/07112.

Particular interest has developed in methods for controlled or targeteddelivery of substances such as drugs (e.g., chemotherapeutic agents),gene therapy compositions (e.g., plasmids, viral vectors, geneticallymodified cells, naked DNA), biological factors (e.g., angiogenicfactors, nerve growth factors, other cell growth factors, otherproteins), monoclonal antibodies, or specific cell types (e.g., stemcells or other progenator cells, pancreatic islet cells, dopaminesecreting neurons, endothelial cells, myocardial cells, other myocytes,etc) into interstitial target locations for the purpose of treatingdiseases such as myocardial ischemia, solid tumor types of cancer,parkansonism, diabetes, etc. Specifically, in the treatment ofmyocardial ischemia, research has indicated that introduction of certainangiogenic substances into ischemic areas of myocardium may result in“therapeutic angiogenesis” in patients who suffer from clinicallysignificant coronary artery disease. Generally speaking, the term“angiogenesis” refers to the creation of new capillaries and/or bloodvessels within the parenchyma of an organ, within a tumor or within anarea of tissue (e.g., myocardium). Angiogenesis is believed to occur asa multistep process in which endothelial cells focally degrade andinvade through their own basement membrane, migrate through interstitialstroma toward an angiogenic stimulus, proliferate proximal to themigrating tip, organize into blood vessels, and reattach to newlysynthesized basement membrane. The term “therapeutic angiogenesis”involves the administration of angiogenic substances or treatments topromote one or more steps in the angiogenesis process thereby providingfor the creation of new blood flow in tissue that previously lackedsufficient blood flow.

Various approaches have heretofore been used for delivery of angiogenicsubstances into the myocardium. One approach is the use a tissuepenetrating device such as a laser to create penetration tracts ortransmyocardial (TMR) channels which extend from either the epicardial(outer) surface or endocardial (inner) surface of the heart into themyocardium, and to then inject quantities of angiogenic substances intothose TMR channels. Examples of this approach are described in U.S. Pat.No. 5,925,012 (Murphy-Chutorian, et al.), U.S. Pat. No. 5,999,678(Murphy-Chutorian, et al.) And U.S. Pat. No. 6,106,520 (Laufer, et al.)

There remains a need in the art for the development of new apparatus andmethods for delivering substances or apparatus to specific target siteswithin tissues, tumors or organs of the body with minimal trauma to thetissues and optimum control as to the precise location(s) at which thesubstances or apparatus are introduced.

SUMMARY OF THE INVENTION

In accordance with the invention, there is provided a system comprisinga) a vessel wall penetrating catheter that is positionable within ablood vessel of a human or animal patient and which has a vessel wallpenetrator advanceable from the catheter, outwardly through the wall ofthe blood vessel in which the catheter is positioned, in the directionof an extravascular target site and b) a delivery catheter that isadvanceable from the penetrator to the target site. Substance(s) orapparatus may then be delivered to the target site through the deliverycatheter and/or samples of body fluid or other information may beobtained from the target site through the delivery catheter. Inapplications where it is desired to use the delivery cathetercontinuously or intermittently over an extended period of time (e.g.,hours, days, weeks or months) the penetrator may be withdrawn into thevessel wall penetrating catheter and the vessel wall penetratingcatheter may be removed, leaving just the delivery catheter in place(e.g., extending through the patients blood vessel(s), outwardly throughthe penetration formed in the blood vessel wall and to the target site.)The types of substances that may be delivered through the deliverycatheter include drugs (thrombolytics, platelet inhibitors,anti-restenotic agents, beta blockers, ion channel antagonists, positiveor negative ionotropic agents, anti-arrhythmics, antibiotics,analgesics, chemotherapeutic agents, other anti-neoplastic agents,etc.), natural or recombinant proteins (e.g., angiogenic proteins suchas vascular endothelial growth factor (VEGF), fibroblast growth factors(FGF), epidermal growth factor (EGF), platelet-derived growth factor(PDGF) nerve cell growth factor (NGF) or hepatocyte growth factor(HGF)), cells or cellular preparations (e.g., stem cells, otherprogenetor cells, myocytes, myoblasts, pancreatic islet cells, dopaminesecreting cells, etc), genes or gene therapy preparations (e.g., viralvectors containing genes for gene therapy applications, genetic materialfor electrophoretic transmission into cells, plasmids, viral vectors,genetically modified cells, naked DNA, etc.), contrast media or dyes forimaging, radio-labeled diagnostic materials or drugs or other traceablesubstances, mixtures of any of the above, alone, in solution or incombination with any delivery substance or matrix (e.g., polymermatrices used to inhibit or slow distribution or dissemination of asubstance away from its original injection site), dialysis solutions ormicro-dialysis solutions, or any other type of substances that may beintroduced through the delivery catheter for any therapeutic, imaging,diagnostic or other purpose.

Further in accordance with the invention, the types of target tissuesinto which the delivery catheter of the above-described system may beplaced include various organs (e.g., heart, brain, liver, pancreas), thewalls of blood vessels (by injection directly into the vessel wall or byinjection into a periadventital area outside of but close to the vesselso that the drug or substance will be distributed into the vessel wall),muscles (e.g., myocardium, skeletal muscle) or aberrant masses (e.g.,tumors, cysts).

Still further in accordance with the invention, substances deliveredthrough the delivery catheter may be of increased viscosity to detertheir egress from the target area, may be adherent to tissues in thetarget area so as to deter egress of the substance from the target areaand/or may harden or form a mass in situ after injection into the targetarea, thereby deterring egress of the substance from the target area.

Still further in accordance with the invention, the outlet port(s) ofthe delivery catheter may be configured such that substances injectedthrough the delivery catheter will form high pressure jet sprays intothe tissue surrounding the delivery catheter.

Still further in accordance with the invention, the vessel wallpenetrator of the vessel wall penetrating catheter and/or the deliverycatheter may be equipped with backflow deterrent for limiting orpreventing fluid that is injected through the delivery catheter frombleeding back through the tissue tract through which the deliverycatheter and/or penetrator was/were advanced. In chronic dosingapplications wherein the delivery catheter remains indwelling, suchbackflow deterrent may comprise a balloon, annular rib or other barrierformed on the outer surface of the delivery catheter to block thebackflow of fluid through the tract in which the delivery catheterresides. In acute dosing applications wherein the delivery catheter isextracted and removed immediately after injection of the substance, thebackflow deterrent may comprise a) an embolizing member such as adetachable blocker, balloon, clot, fibrin, bead of polyvinyl alcohol,etc. that is deployed into the tissue tract as the delivery catheterand/or penetrator is/are retracted, b) a substance such as acyanoacrylate, polyethylene glycol, hydrogel, fibrin glue or othermaterial is injected to embolize, seal or close the tract through whichthe delivery catheter and/or penetrator was/were advanced or c) a tissuefusing device, such as a radio-frequency emitting electrode, for weldingor fusing adjacent tissue in a way that effectively closes the tractthrough which the delivery catheter and/or penetrator was/were advanced.

Still further in accordance with the invention, the delivery catheter ofthe above-described system may be used for aspiration of samples ofblood or body fluid from the target site and/or may include one or moreinteractive members, such as emitters, detectors, electrodes, sensors,etc. for a) facilitating the delivery catheter's penetration throughtissue, b) facilitating the distribution of an injected substance intosurrounding tissues (e.g., by iontophoresis), c) creating a pocket intowhich a substance may be injected or d) sensing the position of thedelivery catheter or some content or variable (e.g., ECG, contractility,force of contraction, pressure, local ECG amplitude, local proteinlevels, local antibody levels, pO₂, pCO₂, oxygen saturation, blood flowrate, pH, local lactate levels, etc.) of the adjacent tissue.

Still further in accordance with the invention, the delivery cathetermay be used to continuously or intermittently monitor physiologicalparameters or variables (e.g., rate of blood flow away from the site) orpharmacokinetic or biodistributive parameters or variables (e.g., therate at which a substance will distribute away from the target site, howlong the injected substance may be expected to remain at the targetsite, the rate at which the injected substance may be inactivated ormetabolized at the target site and/or other parameters/variablesrelating to the activity of the substance after it has been injected atthe site). Such information may then be used to verify that the deliverycatheter is suitably placed for optimal or desired therapeutic effect ofan injected substance or apparatus delivered to the site. If it isdetermined that an injected substance is likely to distribute away fromthe target site too quickly, or remain at the target site for too long,or become inactivated too quickly or not quickly enough, the deliverycatheter may be reposition to a site that is more desirable. Similarly,if it is determined that the site is too vascularized or notvascularized enough for the desired therapeutic or diagnostic activityof the delivered substance or apparatus, the delivery catheter may berepositioned to a new target site that is suitably vascularized, beforecontinuing with delivery of the substance or apparatus through thedelivery catheter. One example of a manner in which this type of sitemonitoring may be accomplished is to deliver radio-opaque dye, aradio-labeled substance or other traceable material through the deliverycatheter and to the location adjacent the outlet port(s) of the deliverycatheter (i.e., the target site to which the therapeutic or diagnosticsubstance is being or will be delivered) Thereafter, the rate at whichthat traceable substance distributes away from that site (or the rate atwhich it becomes inactivated, degraded or metabolized) may be measuredby appropriate means such as x-ray (when radio-opaque traceable materialis used) or radio-scanning (when radio-labeled traceable material isused). If the site is deemed to be acceptable, the therapeutic ordiagnostic substance or apparatus may be delivered to the site. If thesite is deemed to be unacceptable (or less than optimal) the deliverycatheter may be repositioned and the test may be repeated. In someapplications, the delivery catheter may have multiple lumens such that atherapeutic or diagnostic substance or apparatus may be deliveredthrough one lumen and a traceable substance useable for sitemonitoring/verification may be delivered through another lumen.

Still further in accordance with the invention, the delivery catheter ofthe above-described system may include anti-obstruction apparatus (e.g.,a mandrel, stylet, inflatable member or semi-permeable barrier) thatallows the desired substances or apparatus to be introduced in thedistal direction through the delivery catheter but prevents cellularingrowth or other matter from invading and obstructing the lumen and/oroutlet port(s) of the delivery catheter. In this manner, the deliverycatheter remains patent, even when it has been indwelling within tissuefor an extended period of weeks or months.

Still further in accordance with the invention, the efficacy ofsubstances injected through the delivery catheter may in someapplications be enhanced by limiting the rate at which the substancedistributes away from the site or otherwise altering the biodistributionand/or pharmacokinetics of the substance after it has been introducedinto the body. This may be accomplished by introducing the substance inthe form of a solid, dry pellet, implant, filament or gel.Alternatively, this may be accomplished by micro-encapsulating or mixingthe substance with a polymer matrix, oil or other drug delivery matrixor material that is prepared before injection or formed in situ or byforming liposomes or colloidal suspensions containing the substance,etc. Another way in which this may be achieved is by causing thesubstance to promptly enter cells rather than allowing the substance toremain disposed in intercellular fluids or intercellular spaces fromwhich the substance my quickly distribute or disseminate away from theinjection site (e.g., by driving the substance into adjacent cells byelectrophoretic means or chemical means, by modifying the properties(e.g., solubility, polarity, pH) of the substance in a manner which willfacilitate its transport into cells, by atomizing or spraying thesubstance as it exits the catheter, or by causing the substance to exitthe catheter at increased velocity or force.

The invention together with additional features and advantages thereofmay best be understood by reference to the following description takenin connection with the accompanying illustrated drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic showing of a human patient who is undergoing aprocedure for transvenous placement of a delivery cannula for ongoingdelivery of drugs or apparatus to an ischemic region of the patient'smyocardium.

FIG. 2 is a broken, side view of one embodiment of a catheter system ofthe present invention.

FIG. 2 a is an enlarged, cut-away view of section 2 a of FIG. 2.

FIGS. 2 b-2 d show, in step-by-step fashion, the manner in which thecatheter system of FIG. 2 may be used to accomplish transluminalplacement of a delivery catheter for delivery of substances or apparatusto an extravascular target location.

FIG. 3 a shows an embodiment of a delivery catheter of the presentinvention which incorporates a subcutaneous injection port for periodicinfusion of fluids through the delivery catheter.

FIG. 3 b shows an embodiment of a delivery catheter of the presentinvention which incorporates an exteriorized Luer fitting for attachemtof a syringe to the delivery catheter for periodic infusion of fluidsthrough the delivery catheter.

FIG. 4 is a partial perspective view of a delivery catheter of thepresent invention having a plurality of side apertures for disseminatedoutflow of fluid therefrom and a balloon for preventing injected fluidfrom backflowing through the tract through which the delivery catheterextends.

FIG. 5 is a partial perspective view of a delivery catheter of thepresent invention having a plurality of side apertures for disseminatedoutflow of fluid therefrom and a stylet member that is insertable intothe lumen of the delivery catheter to block the side apertures at timeswhen no fluid is being infused through the delivery catheter.

FIG. 6 a is a partial perspective view of a delivery catheter of thepresent invention having a plurality of side apertures for disseminatedoutflow of fluid therefrom and any inflatable obturator position withinthe lumen of the delivery catheter in an inflated state wherein theobturator blocks the side apertures at times when no fluid is beinginfused through the delivery catheter.

FIG. 6 b is a partial perspective view of the delivery catheter of FIG.6 wherein the obturator is in a deflated state such that fluid may beinfused through the lumen of the delivery catheter and out of the sideapertures.

FIG. 7 is a partial longitudinal sectional view of a delivery catheterthe present invention having a plurality of side aperture is fordisseminated outflow of fluid therefrom and a semi-permeable diffusionbarrier mounted about the catheter such that fluid infused through thelumen of the delivery catheter and out of the side apertures willcollect within the diffusion barrier and will subsequently diffuseoutwardly through the barrier while the diffusion barrier preventscellular matter or other material from invading and obstructing the sideapertures or lumen of the delivery catheter.

FIG. 8 a is a partial longitudinal sectional view of a delivery catheterthe present invention having an open distal end and a spring mounted tipmember having a fluid outlet channel formed therein, such tip memberbeing in a retracted position wherein the fluid outlet channel is fullycovered by the catheter body and cellular matter or other material isprevented from invading and obstructing the fluid outlet channel.

FIG. 8 b is a partial longitudinal sectional view of the deliverycatheter of FIG. 8 a, wherein fluid is being infused in the distaldirection through the lumen of the delivery catheter and the pressure ofthe fluid has advanced the distal tip member to an extended positionwherein the fluid outlet channel uncovered and fluid is permitted toflow from the lumen of the delivery catheter, outwardly through thefluid outlet channel.

FIG. 9 a is a partial perspective view of a delivery catheter thepresent invention having an open distal end and a coil spring mountedtip member mounted thereon, such tip member being in a retractedposition wherein the convolutions of the coil spring are contracted intoabutting contact with each other, thereby closing the lumen of thedelivery catheter and preventing cellular matter or other material frominvading and obstructing the lumen of the delivery catheter.

FIG. 9 b is a partial perspective view of the delivery catheter of FIG.9 a wherein fluid is being infused in the distal direction through thelumen of the delivery catheter and the pressure of the fluid hasadvanced the distal tip member to an extended position wherein theconvolutions of the coil spring are spaced apart and fluid is permittedto flow from the lumen of the delivery catheter, outwardly through thespaces between the convolutions of the coil spring.

FIG. 10 is a diagram of a human heart showing the manner in which adelivery catheter of the present invention may be transvenouslyimplanted within an interstitial target site of the myocardium.

FIG. 10 a is an enlarged, cut-away view of a portion of FIG. 10, showingthe manner in which the delivery catheter extends through the wall of acoronary vein and in generally tangential relationship to the adjacentleft ventricle of the heart.

FIG. 11 is a diagram of a human heart showing the manner in which adelivery catheter of the present invention having a backflow preventingballoon thereon may be positioned within a coronary vein to deliver asubstance to a target region of the myocardium by selective, retrogradeinfusion through the coronary vein.

FIG. 12 is an enlarged, cut-away view of a portion of FIG. 11, showingthe backflow preventing balloon in an inflated state and a substancebeing infused through the delivery catheter and through the coronaryvein in the retrograde direction.

FIG. 13 is a partial, side view of a vessel wall penetrating catheter ofthe present invention showing the varying angles at which the vesselwall penetrating member may be deployed, relative to the longitudinalaxis of the catheter body, depending on the extent to which the vesselwall penetrating member has been advanced.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The following detailed description, and the drawings to which it refers,are provided for the purpose of describing and illustrating certainexamples or embodiments of the invention only and are not intended toexhaustively describe or show all possible embodiments or examples ofthe invention.

Generally, one method of the present invention may carried out by firstinserting a vessel wall penetrating catheter into the vasculature of ahuman or veterinary patient, advancing the vessel wall penetratingcatheter through the vasculature to a location within a blood vesselthat is adjacent or near a target location at which a substance (e.g. adrug, biological or therapeutic agent) or apparatus (e.g. a sensor) isto be delivered and thereafter advancing a vessel wall penetrator fromthe catheter, transmurally through the wall of the blood vessel, in thedirection of the target location. In some embodiments, the vessel wallpenetrator itself may comprise a tubular member through which asubstance or apparatus may be passed. In those embodiments, thepenetrator will be advanced all the way to the target location(s) andthe substance or apparatus will then be infused or delivered through thelumen of the penetrator. In other embodiments, a separate deliverycatheter will be advanced through the vessel wall penetrator to thetarget location and, thereafter, the vessel wall penetrator may bewithdrawn and removed (along with the entire vessel wall penetratingcatheter) leaving only the delivery catheter in place. This secondarycatheter may then remain indwelling for whatever period of time isdesired, to allow samples to be withdrawn from the target location or toallow therapeutic agents and/or apparatus (e.g. wires or sensors) to beintroduced to the target location at desired intervals or on a desiredschedule.

A. Transluminally Deployable Catheter System for Acute or ChronicDelivery of Substances or Apparatus to Interstitial Target Sites:

FIGS. 2-2 d show an example of a catheter system 10 of the presentinvention. This system 10 comprises the combination of a vessel wallpenetrating catheter 11 and a delivery catheter 12. FIG. 1 shows thiscatheter system 10 in use on a human patient.

Vessel Wall Penetrating Catheter

In the embodiment illustrated, the vessel wall penetrating catheter 11includes an elongated catheter body 13 having a proximal end 15, adistal end 17, a handle 19 and a hub 21 coupled to the proximal end ofthe catheter body and to the handle. The handle 19 may also serve as acontroller for use in advancing and retracting the vessel wallpenetrator 85, as described more fully below.

The vessel wall penetrating catheter body 13 includes a relatively rigidproximal section 23 shown in FIGS. 2 and 3 a which may be constructed,for example, of a metal hypo tube and an elongated flexible distalsection or region 25 suitably joined to the proximal section. At leastthe distal section 25 is sized to be received within a coronary artery,and therefore can be received within either a coronary artery or acoronary vein. The catheter body section 13 has a penetrator lumen 27which terminates distally at an exit location or exit port 29 that islocated on a peripheral wall 31 of the catheter body. A vessel wallpenetrator, such as a hollow NiTi needle as shown in FIGS. 2 a (phantomlines), 2 b and 2 c, is disposed within the penetrator lumen 27 and isadvanceable out of the side exit port 29 as seen in FIGS. 2 a-2 c. Theexit port 29 is preferably located a short distance proximally of thedistal end 17. A radiopaque marker 33 may be mounted on the lumen 27adjacent the exit port 29 to facilitate placement and positioning of thevessel wall penetrating catheter 11.

The catheter body 13 also has a guidewire lumen 35 (FIG. 3 a) whichextends to the distal end 17 of the catheter body 15. In thisembodiment, the guidewire lumen 35 extends proximally to an inlet port37 at the peripheral wall 31 closely adjacent the proximal section 23.

A major section 51 of the catheter body 13 terminates distally in adistal opening 53, and the catheter body includes a distal tip section55 of soft, flexible, biocompatable material (FIGS. 3 a and 3 b). Aproximal portion 56 of the distal tip section 55 is received in thedistal opening 53 and a distal portion of the distal tip section extendsdistally to the distal end 17. The distal portion of the distal tipsection 55, i.e. the portion of the distal tip section 55 which extendsbeyond the distal end of the major section 51 is of smaller crosssectional area than the adjacent region of the major section to therebydefine an annular shoulder 57 on the catheter body 13. The exit port 29is spaced slightly proximally of the shoulder 57.

Guidance Elements

In many embodiments, it will be desirable for the vessel wallpenetrating catheter 11 to include a guidance element for guiding thepositioning and rotational orientation of the catheter 11 within thevasculature such that the vessel wall penetrator 85 will be properlyaimed in the direction of the target site. Such guidance element mayinclude marker(s), imaging apparatus, emitter(s), sensor(s) etc. In theparticular embodiment shown in FIGS. 2 a and 2 b, the guidance elementcomprises the combination of an imaging transducer 81 and an imageablemarker assembly 101. The imaging transducer 81 is fixedly mounted on thecatheter 11, and in the embodiment illustrated in FIG. 3 a, the imagingtransducer is mounted on the distal tip section 55 just distally of theshoulder 57. In this embodiment, the imaging transducer 81 is a phasedarray transducer and is operative to image 360° about the vessel wallcatheter 11. The imaging transducer 81 is coupled to a multiplex circuit83 which is within the major section 51 of the catheter body 13 adjacentthe shoulder 57, and the multiplex circuit 83 is in turn coupled toleads 85 which extend through the lead lumen 39, through the handpeice19 and are attached to a connector 86 which allows the leads 39 to beconnected to a viewing instrument and screen. When activated, theimaging transducer emits ultrasound signals and receives back echos orreflections which are representative of the nature of the surroundingenvironment. The imaging transducer provides an imaging signal fromwhich an image of the surrounding structure can be created on a screenof the viewing instrument. In a preferred practice of this invention,the phased array transducer, the accompanying circuitry and the separateviewing instrument/screen may be obtained from Endosonics, Inc. ofRancho Cordova, Calif.

In an alternate embodiment of this invention, the imaging element may beformed of a single rotating crystal or transducer. In this embodimentthe transducer would have a single lead out, would include a drive shaftwhich would run back to the proximal end of the catheter through 39.

In the particular embodiment shown, an imageable marker 101 is fixedlymounted on the catheter body 13 in a known circumferential orientationrelative to the exit port 29. This marker 101 may be in the form of astructure or cage, as shown, and the transducer 81 may be located withinthe marker cage or marker structure. In the embodiment shown, the markercage comprises a plurality of longitudinal members 103 disposed atcircumferentially spaced apart locations about a hollow interior space105. The hollow space 105 receives the distal tip section 55 and thetransducer 81, and the transducer 81 is an onboard transducer in that itis inseparable from and not removable from the catheter body 13. One ofthe longitudinal members is located at a circumferential position thatis axially aligned with the exit port 29 and consequently is alsoaxially aligned with the path that will be followed by a tissuepenetrator that is advanced from the catheter body 13 through the exitport. Thus, the imageable marker 101 forms on the image obtainable fromthe imaging signal from the imaging transducer a penetrator pathindication that indicates the path that will be followed by the tissuepenetrator when the tissue penetrator is advanced from the catheter. Asan alternative to the use of a marker 101, the path that will befollowed by the penetrator may be indicated on the image by electronicmeans or by the use of a computer program, thereby eliminating the needfor a penetrator path indicating marker 101. In many embodiments, themarker 101, electronic penetrator path indicator or computer program fordetermination of the penetrator path may not only indicate thetrajectory or path of the penetrator but may also indicate a stoppingpoint at which advancement of the penetrator will stop or is intended tostop. By providing such an indication of the mandatory or intendedstopping point of the penetrator advancement, the operator may case thepenetrator to be optimally positioned at the intended site withoutadvancing the penetrator too far as may result in missing of theintended delivery site or unwanted penetration of a blood vessel orother anatomical structure that lies beyond the site at which thepenetrator is desired to stop.

With the construction described above, the imaging transducer 81 and themarker 101 are both mounted on the distal tip section 55 which has asmaller cross sectional area than does the adjacent region of the majorsection 51 of the catheter body 13. Accordingly, the cross sectionalarea of the catheter body 13 at the region containing the imagingtransducer 81 and the marker 101 can still be relatively small. Also,the exit location 29 is closely adjacent to the imaging transducer 81and may be, for example, about 5 mm from the imaging transducer. Thisminimizes the likelihood of any significant torsional displacement ofthe exit location 29 relative to the marker 101 and imaging transducer89. It may also be appreciated that the imaging transducer may bemounted such that the exit port is located directly at the point atwhich the transducer is affixed to the catheter, illuminating anydisplacement.

It will be appreciated that various other types of imaging or positionsensing apparatus may be used as alternatives to the above-describedimaging transducer 89/marker 101 combination to guide and orient thevessel wall penetrating catheter 11. For example, the vessel wallpenetrating catheter 11 may incorporate an emitter that is useable inconjunction with an electromagnetic, potentiometric, or otherelectro-anatomical mapping and/or catheter guidance/positioning systems,such as those commercially available from or under development byBiosense Webster, Inc., Diamond Bar, Calif.; Cardiac PathwaysCorporation, 995 Benicia Avenue, Sunnyvale, Calif. and/or Stereotaxis,Inc., 4041 Forrest Park Avenue, St. Louis, Mo. Examples of these typesof catheter guidance or positioning systems are described in U.S. Pat.No. 5,820,568 (Willis), U.S. Pat. No. 5,931,818 (Werp et al.), U.S. Pat.No. 5,654,864 (Ritter et al.), U.S. Pat. No. 5,928,248 (Acker), U.S.Pat. No. 5,752,513 (Acker et al.), U.S. Pat. No. 5,558,091 (Acker etal.) And U.S. Pat. No. 5,833,608 (Acker), the entire disclosures ofwhich are expressly incorporated herein by reference.

Delivery Catheter

After the vessel wall penetrator 85 has been advanced to the desiredextended position, the delivery catheter 12 may be advanced through thelumen of the penetrator 85 and out of its distal end. For applicationswhere it is desired for the delivery catheter 12 to penetrate intomyocardial tissue, the delivery catheter 12 may comprise a smallcannula, hypotube or microcatheter formed of a suitable material such aspolyimid, polytetrafluoroethylene, polypropylene, polyethylene, Pebax™,etc. For many applications, including application wherein the deliverycatheter 12 is used to deliver substances into the myocardium, thedelivery catheter 12 may have an outer diameter of approximately0.25-0.5 mm. In embodiments where it is intended for the deliverycatheter to penetrate through tissue as it advances the distal tip ofthe delivery catheter 12 may be beveled or sharpened. Optionally, thedelivery catheter 12 may have an energy emitting distal tip for enhancedtissue penetrating capability. For example, a radiofrequency electrodemay be located on or near the distal tip of the delivery catheter toprovide for tissue penetration enhanced by RF energy emission. Or, thedelivery catheter may be adapted to ultrasonically vibrate, therebyimproving its ability to penetrate through tissue.

The body of the delivery catheter 12 may be radio-opaque or one or moreradio-opaque markers may be formed on the delivery catheter (e.g., atits distal tip) to permit imaging of the catheter and determination ofthe position of the catheter within the patient's body.

In some applications, such as those where drugs, substances or apparatusare to be chronically delivered to the target site over a period ofdays, weeks or months, the delivery catheter will be allowed to remainindwelling after the vessel wall penetrating catheter 11 has beenremoved. To facilitate this, a detachable or removable Luer connector 47may mountable proximal end of the delivery catheter 12 as shown in FIGS.2 and 3 b. This detachable or removable Luer connector may be removedwhen during proximal withdrawal and removal of the vessel penetratingcatheter 11 while the delivery catheter 12 remains in place. Thereafter,in embodiments wherein the proximal end of the delivery catheter 12remains exteriorized, the removable or detachable Luer connector 47 maybe attached to the exteriorized proximal end of the delivery catheter 12and may thereafter be used for subsequent attachment of a stopcock 47and/or syringe 50 as shown in FIG. 3 b. In other embodiments, theproximal end of the delivery catheter 12 may be devoid of any hub orconnector and may be connected to a pump, delivery device,subcutaneously implanted reservoir or injection port 52, as shown inFIG. 3 a.

An opening for infusion or aspiration of substances/apparatus may beformed in the distal end of the delivery catheter 12 and/or one or morefluid outlet openings may be formed in the sidewall of the deliverycatheter 12, near its distal end, as shown in FIG. 2 c or 2 d. For manyapplications, one or more openings may be laser drilled into thedelivery catheter 12, such openings being no more than ½ the diameter ofthe catheter lumen through which the substance is being injected, suchthat high pressure jets of the substance will be created as thesubstance exits the delivery catheter 12. The creation of such elevatedpressure as the substance exits the delivery catheter 12 serves topropel or drive the substance through cell membranes and intointracellular spaces cells rather than allowing the substance to remainin intercellular spaces (i.e., spaces or fluids between cells or outsideof the cells) from which the substance would more rapidly distributeaway from the injection site.

Interactive Apparatus on Delivery Catheter

As shown in FIG. 2 c, one or more interactive members 52 such assensors, emitters, etc. . . . may be positioned on or near the distalend of the delivery catheter 12 for emitting energy as described aboveor for sensing, sampling or receiving information from the tissuesadjacent the distal portion of the delivery catheter 12. Interactivemembers that comprise sensor(s) may provide information on the positionof the delivery catheter 12 or measurements of variables such as ECG,contractility, force of contraction, pressure, local ECG amplitude,local protein levels, local antibody levels, pO₂, pCO₂, oxygensaturation, blood flow rate, pH, local lactate levels, etc. By use ofsuch information received from the target site, the clinician may assessor characterize the target site to ascertain its suitability beforeintroducing a substance or apparatus into the target site.

In applications where it is desired to facilitate the passage ordistribution of an injected substance into the surrounding tissue, theinteractive member 52 may emit some facilitating energy, such as anelectromagnetic field for iontophoretic transmission of the substancethrough the adjacent tissue.

In other applications, the interactive member 52 may emit energy, suchas radiofrequency energy, that will create a pocket in the surroundingtissue such that a substance or apparatus my be introduced into thatpocket. The walls of the pocket may be seared by the energy so as toslow the distribution of the substance out of the pocket.

In other applications, the interactive member 52 may emit energy, suchas ultrasound, that facilitates distribution of a substance bypermeating cell membranes or by vibrating the catheter tip.

Apertures for High Pressure Injection from Delivery Catheter

As shown in FIGS. 2 c and 2 d, the distal end of the delivery cathetermay be closed and a plurality of small side apertures 24 may be formedin the sidewall of the delivery catheter 12 to provide for high pressureoutflow of fluid from the deivery catheter and into the surroundingtissues.

Backflow Deterrent Apparatus on Delivery Catheter and/or Penetrator

In some applications, the injection of fluids through the deliverycatheter 12 into a closely confined space or interstitial site mayresult in some regurgitation or backflow of the injected fluid throughthe tract through which the vessel wall penetrator 85 and/or deliverycatheter 12 were advanced. In acute dosing situations where the deliverycatheter is removed immediately after the dose, this backflow of theinjected fluid may be prevented by sealing the penetration tract or byintroducing a material (e.g., an adhesive or embolizing material) intothe tract during immediately after removal of the catheter 12. This maybe accomplished by injecting a suitable adhesive or embolizing materialsuch as a cyanoacrylate, polyethylene glycol, hydrogel, fibrin gluethrough the delivery catheter lumen as the delivery catheter 12 is beingpulled back through the tissue tract through which it was initiallyinserted. In other applications where the delivery catheter 12 remainsindwelling, the backflow of fluid may be accomplished by a backflowbarrier 22 (see FIG. 4) such as an annular rib or inflatable balloonformed on the shaft of the delivery catheter 12 near its distal end soas to block backflow of fluid around the catheter shaft or alternativelyby causing the fluid to solidify or become gelatinous such that it cannot backflow through the penetration tract. Such gelling orsolidification of the injected fluid may be accomplished by subsequentinjection or pre-mixing of the fluid with an oil, a gelatinous polymercarrier or reactant that will cause the desired thickening orsolidification of the injected fluid.

Anti-Obstruction Apparatus for Maintaining Patency of Delivery Catheter

In some embodiments, especially those in which the delivery catheter 12is allowed to remain indwelling for chronic delivery of substances orapparatus to the target site, the delivery catheter may incorporateanti-obstruction apparatus that will prevent cellular ingrowth or othermatter from obstructing the lumen or outfow port(s) of the deliverycatheter 12. Examples of such anti-blocking apparatus are shown in FIGS.5-7.

In the embodiment of FIG. 5, the delivery catheter has a closed distalend 28 and a plurality of side outlet apertures 24. A solid stylet 26 isinsertable through the lumen of the delivery catheter and the outerdiameter of the stylet 26 is approximately the same as the innerdiameter of the delivery catheter such that, when inserted, the stylet26 will substantially close-off or block the side apertures 24 therebypreventing cellular ingrowth or other matter from entering the sideapertures 24 or lumen of the delivery catheter. Thus, the stylet 26 maybe inserted into the delivery catheter at times when no fluids or othersubstances are being infused, but may be removed at appropriate times toallow the desired infusions of fluids or other substances through thedelivery catheter.

In an alternative variation of the embodiment shown in FIG. 5, thestylet 26 could have a lumen which extends longitudinally through thestylet to a closed distal end and side aperture(s) or slot(s) or otheropening(s) could be formed in the stylet so as to be alignable with theside apertures 24 of the delivery catheter. In such embodiment, thestylet would be maintained in one position when it is desired to blockthe side apertures 24 to prevent cellular ingrowth or other matter fromentering the side aperture's or lumen of the delivery catheter but maybe rotated or otherwise moved to a second position wherein theaperture(s), slot(s) or other opening(s) of the style at 26 would becomealigned with the side aperture's 24 of the delivery catheter is suchthat fluid may be injected through the lumen of the style that andoutwardly through the side apertures of the delivery catheter 24.Thereafter, when the fluid injection has been completed, the styletcould be once again rotated or otherwise moved to the first position toonce again close-off or block the side apertures 24 of the deliverycatheter.

FIGS. 6 a and 6 b show another embodiment wherein the delivery catheterhas a closed distal end 28 and a plurality of side outlet apertures 24.In this embodiment, an inflatable obturator 30 is disposed within thelumen of the delivery catheter. When the obturator 30 is inflated, asshown in FIG. 6 a, it will close-off or block the side apertures 24thereby preventing cellular ingrowth or other matter from entering theside apertures 24 or lumen of the delivery catheter. However, when theobturator 30 is deflated, as shown in FIG. 6 b, fluids may be infused inthe distal direction through the lumen of the delivery catheter and outof the side apertures 24.

In the embodiment of FIG. 7, a semi-permeable diffusion barrier 58 ismounted about the outer surface of the delivery catheter so as to coverthe catheter's side apertures 24. This diffusion barrier 58 is in thenature of a balloon and is formed of material that permits thesubstances or fluids injected through the catheter to diffuse outwardlythrough the barrier 58, but also prevents cellular ingrowth or othermatter from invading the interior of the barrier 58 and entering theside apertures 24 or lumen of the delivery catheter. The desiredsemi-permeability of the diffusion barrier 58 may be a function of thesize of pores or openings in the barrier or balloon 24. Thus, polymerfilms having appropriately sized pores may be used to form the diffusionbarrier 58. One polymer material that may be used in film form to createthe diffusion barrier 58 is commercially available as Nutrapore™ fromAnamed, Inc., 1 Technology Drive, Bldg. D-409, Irvine, Calif. 92618.

FIGS. 8 a and 8 b show another embodiment of a delivery catheter 12having it opened distal end and a spring-mounted tip member 42 disposedwithin the distal end of the catheter 12. The tip member 42 has a fluidflow channel 44 that extends through the tip member 42 and opens throughthe side of the tip member 42, as shown. The tip member 42 is attachedto the catheter 12 by way of a spring 40. The spring 40 is biased to acontracted position as shown in FIG. 8 a, wherein the tip member 42 isdrawn into the lumen of the catheter 12 such that the side opening ofthe fluid flow channel 44 is covered by the wall of the catheter 12 andcellular ingrowth or other matter is thereby prevented from entering thefluid flow channel 44 or lumen 32 of the delivery catheter 12. However,as shown in FIG. 8 b, when fluid or some substances injected in thedistal direction through the lumen 32 of the catheter 12, the pressureof the fluid or other substance will overcome the bias of the spring 40,causing the tip member 42 to advance to a second position whereby theside opening of the fluid flow channel 44 becomes unobstructed and theinjected substance or fluid is permitted to flow outwardly through thefluid flow channel 44 and out of its side opening, into the surroundingtissue. Thereafter, when the substance or fluid is no longer beinginjected, the bias of the spring 40 will cause the tip member 42 toretract to its first position as shown in FIG. 8 a.

In the embodiment shown in FIGS. 9 a and 9 b, there is provided adelivery catheter 12 that has an open distal end, a generally conicaltip member 408 and a coil spring member 46 which attaches the tip member48 to the distal end of the catheter 12. The coil spring member 46 isbiased to a retracted position, as shown in FIG. 9 a, wherein theconvolutions of the coil spring member 46 are drawn into abutment withone another and with the respective ends of the catheter body 12 and tipmember 48. In this manner the distal end of the catheter 12 issubstantially closed, and cellular ingrowth or other matter is preventedfrom invading the lumen of the catheter 12. However, as shown in FIG. 9b, when a fluid or substance is injected through the lumen of thecatheter 12 the pressure of the injected fluid or substance willovercome the bias of the coil spring member 46, thereby causing the tipmember 46 to advance in the distal direction and the convolutions of thecoil spring member 46 to separate such that spaces 46 a will existbetween the individual convolutions of the coil spring member 46. Theinjected substance or fluid will thus flow outwardly through the spaces46 a and into the surrounding tissue. After the injection of thesubstance or fluid has stopped, the bias of the coil spring member 46will cause the tip member 48 to become retracted and the device willassume its closed configuration as shown in FIG. 9 a.

Another way in which the patency of the lumen of the delivery catheter12 may be maintained is by constant infusion and withdrawal of fluidtherethrough. In this regard, fluid may be continually or periodicallyinfused into a tissue pocket or reservoir at the distal end of thedelivery catheter 12 and subsequently re-aspirated through the deliverycatheter lumen. Alternatively, the delivery catheter 12 may havemultiple lumens, one for infusion of fluid and one for withdraw offluid, and a periodic or continual infusion and withdrawal of fluid maybe performed to keep these lumens of the delivery catheter 12 open andunobstructed with cellular ingrowth, clots, debris or other matter.

Apparatus/Substances for Anchoring of Delivery Catheter

The delivery catheter 12 may incorporate mechanical hooks, screws, barbsor other anchoring members (not shown) that engage surrounding tissueand deter inadvertent migration or movement of the delivery catheter 12after it has been implanted. Such anchoring members may be formed ofbioabsorbable material and may be designed to break away, detach upondelivery of a pulse of energy or to be otherwise jettisoned when thedelivery catheter 12 is purposefully removed from the body. In instanceswhere the optional interactive member 52 comprises an energy emitter orelectrode, such as a radiofrequency electrode, such interactive member52 may be actuated after the delivery catheter 12 is in place for thepurpose of fusing the catheter 12 to the surrounding tissue. Also,chemical glues, adhesives, or an ingrowth matrix such as a fabric (e.g.,a woven material such as Dacron) into which surrounding tissue willgrow, may be disposed on the delivery catheter 12 or introduced throughthe delivery catheter 12 after it is positioned, to deter inadvertentmovement of the delivery catheter 12.

Other Surface Treatments of the Delivery Catheter

Apart from the above-described disposition of glues, adhesives or aningrowth matrix on the surface of the delivery catheter 12 to facilitateits anchoring, there may additionally be other types of surfacematerials or surface treatments applied to the delivery catheter 12 forvarious other reasons. For example, the outer surface of at least theportion of the delivery catheter that becomes inserted into thepatient's body may be coated or impregnated with and antibiotic orantimicrobial substance (e.g. provodine iodine, silver compounds, etc.)or other drugs or substances that affect the surrounding tissue in adesired way (e.g., a heparin coating that will reduce clot formation inareas adjacent to the catheter or within the blood vessels through whichthe catheter extends). One example of an anti-microbial coating that maybe applied to the delivery catheter 12 is a proprietary materialcontaining silver, carbon and platinum and used commercially under thename Oligon™(Edwards Lifesciences Corporation, Irvine, Calif.). Examplesof commercially available heparin coatings that may be used includeheparin-benzalkonium chloride complex, heparin-TDMAC complex and othermedical coatings available from STS Biopolymers, Inc. 336 Summit PointDr., Henrietta, N.Y.

Apparatus for Creating Pocket into which Substance or Apparatus isIntroduced:

The delivery catheter 12 may optionally incorporate, or may be used inconjunction with, apparatus for creating a pocket (e.g., a void) withintissue located adjacent to the outflow aperture(s) 24 of the deliverycatheter 12 such that substances infused through or apparatus introducedthrough the delivery catheter 12 will be received within that pocket.For example, an expandable cage may be deployable through or from thedelivery catheter 12 to spread or separate the adjacent tissue, therebycreating the desired pocket. Or, the above-described interactive member52 may comprise an energy emitting apparatus capable of creating apocket adjacent thereto. In this regard, the interactive member 52 maycomprise a radiofrequency electrode that, when actuated, will ablate theadjacent tissue thereby creating the desired pocket. Alternatively, thepocket creating apparatus may comprise a laser port through whichablative laser energy may pss into the adjacent tissue, or a nozzlethrough which a high pressure jet of fluid may be injected so as tosever or separate the adjacent tissue, thereby creating the pocket.

Variable Delivery Catheter Trajectory from Single Penetrator

FIG. 13 shows that the vessel wall penetrator 85 may be of a pre-bent,curved configuration such that incremental advancement of the penetratormay cause its distal tip to be incrementally positioned at a series ofdifferent locates, such as point A (PA), point B (PB), point C (PC) andpoint D (PD) shown in FIG. 13. The delivery catheter 12 may then beadvanced out of the penetrator at each of the points and drug orsubstances may be injected at periodic depot locations DL along the pathof each advancement or retraction of the delivery catheter 12. In thismanner, the drug or other substance may be deposited relativelyuniformly over a generally wedge shaped region of tissue with only onepenetration through the vessel wall.

B. Procedure for Transluminal Placement of a Delivery Catheter Withinand Interstitial Target Site and Acute or Chronic Delivery of Substancesor Apparatus to the Target Site:

FIG. 1 generally depicts a catheter system 10 of the above-describedtype being used to perform a procedure for transvenous placement of adelivery catheter 12 in an ischemic region of the patient's myocardium(i.e., the target site) so that a substance or apparatus may be acutelyor chronically delivered directly into the target site.

This procedure begins with the percutaneous insertion of the vessel wallpenetrating catheter 11 into the patient's femoral vein and advancementof the vessel wall penetrating catheter 11 trough the inferior venacava, through the right atrium, through the coronary venous sinus andinto a coronary vein as shown in detail in FIG. 11. A vessel wallpenetrator 85 is then advanced from the vessel wall penetrating catheter11 and through the wall of the coronary vein in which the vessel wallpenetrating catheter 11 is positioned. Thereafter, a delivery catheter12 is advanced through the vessel wall penetrator 85 to the targetlocation within the patient's myocardium.

In many applications, the vessel wall penetrating catheter 11 will beprovided with or associated with guidance elements as describedhereabove to guide the positioning, rotational orientation of thecatheter 11 within the patient's body and/or the path, trajectory andextent of advancement of the penetrator 85. Typically, these guidanceelements will be used to guide the longitudinal position and rotationalorientation of the vessel wall penetrating catheter 11 before thepenetrator 85 is advanced from the catheter 11. Thereafter, after thedelivery catheter 12 has been advanced through the penetrator 85 to thetarget site, the penetrator 85 may be retracted into the vessel wallpenetrating catheter 11 and the vessel wall penetrating catheter 11 maybe withdrawn and removed, leaving only the delivery catheter 12 inplace.

Optionally, as shown in FIG. 2 c, an interactive member 52 such as anemitter, sensor, marker, electrode, etc. may be mounted on the deliverycatheter 12. This interactive member 52 may be sensor (e.g., anelectrode, optical sensor, chemical sensor, strain gage, flow meter,etc) that is connected to a receiver or instrumentation located outsidethe patient's body so as to provide information or analytical dataregarding from the target site TS. Examples of the types of informationor data that may be sensed and provided from the target site includeECG, contractility, force of contraction, pressure, local ECG amplitude,local protein levels, local antibody levels, PO₂, pCO₂, oxygensaturation, blood flow rate, pH, local lactate levels, etc.

Substances or apparatus may be introduced through the lumen of thedelivery catheter 12 at desired time points or intervals. Also, separatesensor(s) or other separate apparatus may be delivered through thedelivery catheter 12 so as to provide diagnostic information or otherinformation regarding the physiological status of the myocardium inwhich the delivery catheter 12 is indwelling and/or the specificpositioning of the distal end of the second catheter 12. After all ofthe desired sampling, diagnosis, delivery of substances and/or deliveryof apparatus has been completed, the dosing catheter 12 may then beremoved from the body of the patient. Some examples of tissuepenetrating catheters 10 useable in this invention include thosedescribed in PCT International Patent Publications No. PCT/US99/07115and PCT/US99/07112.

The delivery catheter 12 may comprise any suitable type of flexiblecatheter sized to pass through the lumen of the vessel wall penetrator85 in the manner described here above. Examples of commerciallyavailable extrusion that may be used to form the delivery catheter 12include a

When the invention is used to deliver substances (e.g., drugs,therapeutic agents, biologicals, etc.) to ischemic site(s) within themyocardium, the types of substances that may be delivered includeangiogenic factors (e.g. VEGF, FGF, EGF, PDGF or Hepatocyte GrowthFactor (“HGF”)), gene therapy compositions (e.g. a replication-deficientadenovirus vector containing a transgene which codes for an angiogenicprotein or peptide), pro-angiogenic agents or combinations (e.g. anadenosine receptor agonist in combination with heparin), myocardialcells, myocytes, myoblasts, or other cardiac or systemic drugs such asantiarithmic agents, beta blockers, calcium channel antagonists,platelet glycoprotein (GP) IIb/IIIa inhibitors, etc.

In some applications, the invention may be used to treatneurdegenerative diseases such as Parkinson's Disease, AmilotrophicLateral Sclerosis (Lou Gehrig's Disease), Alzheimer's Disease, etc.) Bydelivering to a target site within the brain or central nervous system asubstance that delays the nerve cell degeneration or causes new nervecells or new nerve cell connections to form, such substances includingbut not limited to glial cell line-derived neurotropic factor (GDNF),nerve growth factor, neuro-immunophilin ligand, poly ADP-Ribosepolymerase, and combinations thereof.

In some applications of the invention, the delivery catheter 12 will beprovided with small side apertures 24 and a closed distal end, or someother aperture or nozzle arrangement, that causes the substance to beexpelled from the delivery catheter 12 in fine, high velocity jets orstreams such that dissemination of the substance into the surroundingtissue will be enhanced. In some instances an interactive member 52 onthe delivery catheter may be used emit energy or otherwise interact withthe delivered substance to affect the substance in a desired way (e.g.,to emit an iontophoretic field to drive the substance into adjacenttissue or to cause the distal tip of the delivery catheter 11 to becomewarm or to vibrate ultrasonically in a way that enhances thedistribution or cell membrane permeation of the substance). Also, insome applications, a substance injected through the delivery catheter 12may be mixed with or followed by a second substance which causes thefirst substance to solidify, gel, adhere or to become otherwise alteredin a desired manner (e.g., in away that affects the distribution,bioavailability, potency, duration of action or pharmacologic activityof the first substance. In this regard, a mixture of angiogenic factors(e.g., VegF and FGF) may be prepared in a liquid polymer matrix andinjected in a bolus through the delivery catheter 12 into a myocardialtarget site. Thereafter, a second solution containing a catalyst thatcauses the polymer matrix to solidify to form a biodegradable solid maybe injected as a second bolus through the delivery catheter. The mixtureof the fist solution with the second solution within the target sitewill cause the fist solution to solidify in the form of a biodegradablesolid or foam. This in situ solidification of the matrix will cause theinjected angiogenic factors to remain within the target site for alonger period of time than if they had been injected and allowed toremain as an aqueous solution. Examples of materials that may be formedin situ in this application include those described in U.S. Pat. No.6,139,574 (Vacanti).

The present invention allows for mapping or assessment of the site atwhich the delivery catheter 12 is positioned to confirm that the siteis, or continues to be, suitable for the intended purpose. For example,a radio-labeled compound, radio-isotope or other traceable substance maybe introduced through the delivery catheter and the rate at which theradio-labeled substance or isotope distributes away from the injectionsite may be measured by well known techniques. If the distribution awayfrom the site is determined to be too rapid or too slow, the deliverycatheter 12 may be repositioned before the desired therapeutic ordiagnostic substance is injected. In chronic dosing applications whereinthe delivery catheter 12 remains indwelling for days or months, thistechnique may be used to ensure that the delivery catheter 12 has notmigrated or moved from the intended injection site, or that the site hasnot become excessively vascularized since delivery of the last dose. Insome applications, it may be desirable for the delivery catheter 12 tohave multiple lumens, such that the desired therapeutic or diagnosticsubstance or apparatus may be delivered through one lumen and atraceable substance useable for mapping or assessment of the target sitemay be delivered through another lumen.

It will be appreciated that the above-described examples of theapplication of the catheter system 10 may further be combined with someor all of the other optional elements of the catheter system 10described here above, such as the high-pressure distribution nozzles,tissue-pocket-creating apparatus, sponges or other apparatus/substancesafford to wait or affect the dissemination or distribution of theinjected substance, anti-obstruction apparatus, apparatus/substances fora three of the delivery catheter, sensors or other apparatus forcharacterization of the targets i.e. or regions adjacent the deliverycatheter, etc.

C. Method for Intravenous Retroperfusion

The present invention further includes a method wherein a retrovenousdelivery catheter 112, a shown in FIGS. 11 and 12, is used to deliver asubstance into a vein while temporarily obstructing the vein, therebyallowing the substance to enter a target ste by undergoing retrogradeflow through the venous vasculature to a capillary bed at the targetsite. The retrovenous delivery catheter 112 generally comprises aflexible tubular catheter described hereabove of the above-describedtype may be inserted into a selected vein (e.g., a coronary vein) andused acutely or chronically to deliver substances to a particular targetsite by retroperfusion of the substance through the vein, to a capillarybed located within the target site. An example of this embodiment of theinvention is shown in FIGS. 11 and 12. As shown, the retrovenouscatheter 112 has a distal end opening and an inflatable occlusionballoon 50 formed a spaced distance proximal to the distal end opening.The catheter 112 is inserted into the venous vasculature and advancedinto a specific vein such as a coronary vein located near an area ofischemic myocardium, as shown in FIGS. 11 and 12. Before a desiredsubstance is delivered through the catheter 112, the occlusion balloon50 is inflated so as to occlude the vein and prevent venous blood fromflowing through the vein in the normal direction of venous blood flow.The desired substance (e.g., a drug or biological) is then injectedthrough the catheter 112 and out of its distal end opening into thevein. Because the vein is occluded by the balloon, the injectedsubstance will flow in retrograde fashion through the vein and to thecapillary bed within the ischemic region of the myocardium. The balloonmay remain inflated for a desired period of time to allow the drug orsubstance to be effectively absorbed by the tissues adjacent to thatcapillary bed. Thereafter, the balloon is deflated, allowing normalvenous flow through the vein. The catheter 112 may be removed after asingle dose is delivered or it may remain indwelling for a period oftime (e.g., hours, days, weeks or months) to permit repeated doses to bedelivered by repeating the foregoing injection procedure. Any or all ofthe attributes and options described above with respect to theextravascular delivery catheter 12 may also be incorporated into thisretrovenous delivery catheter 112, to the extent feasible and notadverse to the intended function of this retrovenous delivery catheteras described herein.

Although exemplary embodiments of the invention have been shown anddescribed, many changes, modifications and substitutions may be made bythose having ordinary skill in the art without necessarily departingfrom the spirit and scope of this invention. Specifically, elements orattributes described in connection with one embodiment may also be usedin connection with another embodiment provided that the inclusion or useof such element or attribute would not render the embodiment in which itis incorporated unuseable or otherwise undesirable for an intendedapplication. Accordingly, all such additions, deletions, modificationsand variations to the above-described embodiments are to be includedwithin the scope of the following claims.

1-137. (canceled)
 138. A catheter device for delivering substances orapparatus to a target site located within the body of a human orveterinary patient, said device comprising: an elongate catheter bodyhaving a distal end, said catheter body being positionable in a bloodvessel lumen; a hollow penetrator member positioned within the catheterbody and advanceable therefrom; at least one imageable marker thatindicates the rotational orientation of the catheter body within theblood vessel lumen, said marker being useable to enable an operator torotationally orient the catheter body relative to the target site suchthat subsequent advancement of the needle will cause the needle to afirst location relative to the target site; and, a delivery catheterthat is advanceable through the hollow penetrator to the target site,the substance or apparatus being deliverable to the target site throughsaid delivery catheter.
 139. A device according to claim 138 wherein themarker is a radiopaque marker.
 140. A device according to claim 138wherein the marker is positioned and configured to mark the location ofthe lumen.
 141. A device according to claim 138 wherein the marker ispositioned and configured to mark the location of the lumen adjacent toan aperture through which the hollow penetrator exits the catheter body.142. A device according to claim 138 further comprising a guidewirelumen.
 143. A device according to claim 138 further comprising a distaltip member on the distal end of the catheter body.
 144. A deviceaccording to claim 143 wherein the distal tip member is formed of soft,flexible material.
 145. A catheter device according to claim 138 furthercomprising an imaging apparatus on the catheter body, said imagingapparatus being useable to image the at least one imageable marker,thereby providing an image to enable the operator to position androtationally orient the catheter body within the blood vessel lumen suchthat subsequent advancement of the needle will cause the needle to enterthe target site.
 146. A system comprising a catheter device according toclaim 138 further in combination with an imaging apparatus that is notlocated on the catheter body, said said imaging apparatus being useableto image the at least one imageable marker, thereby providing an imageto enable the operator to position and rotationally orient the catheterbody within the blood vessel lumen such that subsequent advancement ofthe needle will cause the needle to enter the target site.
 147. A systemaccording to claim 146 wherein the imaging device comprises afluoroscope.
 148. A system comprising a catheter device according toclaim 138 further in combination with a delivery catheter that isadvanceable through the hollow needle to the target site, the substancebeing deliverable through the delivery catheter.
 149. A system accordingto claim 148 wherein the catheter device is removable leaving thedelivery catheter in position within the patient's body.
 150. A systemaccording to claim 149 wherein the delivery catheter has a lumen and anoutflow opening and wherein the system further comprises a matterblocking member that substantially deters unwanted matter from enteringthe outflow opening.
 151. A system according to claim 150 wherein thematter blocking member comprises a selectively permeable barrier thatallows desired substances to be infused in the distal direction throughthe outflow opening and to the target location but prevents cellularingrowth and other matter from entering the lumen of the deliverycatheter through said outflow opening.
 152. A system according to claim151 wherein the selectively permeable barrier is a balloon attached tothe delivery catheter such that substances infused through the lumen ofthe delivery catheter collect within the balloon and subsequentlydiffuse outwardly through the balloon.
 153. A system according to claim151 wherein the matter blocking member comprises a stylet that isinsertable into the lumen of the delivery catheter to block the entry ofmatter into the lumen of the delivery catheter lumen.
 154. A systemaccording to claim 153 wherein the stylet is removable from the lumen ofthe delivery catheter to permit delivery of a substance or apparatusthrough the delivery catheter.
 155. A system according to claim 148wherein the delivery catheter comprises: a first tube having a lumen anda sidewall in which an outflow aperture is formed; and, a second tuberotatably disposed in a coaxial position within the first tube, saidsecond tube having a lumen, a closed distal end and a sidewall in whichan opening is formed; the second tube being rotatably moveable betweeni) a blocking position wherein the side wall of the second tubesubstantially blocks the outflow aperture of the first tube to preventcellular ingrowth and other matter from entering the lumen of the secondtube and ii) an infusion position wherein the opening of the second tubeis aligned with the outflow opening of the first tube such that asubstance that is injected into the lumen of the second tube will flowthrough the opening of the second tube and through the outflow openingof the first tube.
 156. A system according to claim 155 wherein aplurality of outflow apertures are formed in the sidewall of the firsttube.
 157. A system according to claim 148 wherein the delivery cathetercomprises: a tube having a lumen and a sidewall in which an outflowaperture is formed; and, an obturator member disposed at least partiallywithin the lumen of the tube, said obturator member being alternatelydisposable in i) a blocking position wherein the obturator substantiallyblocks the outflow aperture of the tube to prevent cellular ingrowth andother matter from entering the lumen of the tube and ii) an infusionposition wherein the obturator does not substantially block the outflowapertures such that fluid may be injected through the lumen of the tubeand out of the outflow aperture.
 158. A system according to claim 157wherein a plurality of outflow apertures are formed in the sidewall ofthe tube.
 159. A system according to claim 157 wherein the obturatormember is an inflatable balloon that assumes said blocking position wheninflated and said infusion position when deflated.
 160. A systemaccording to claim 148 wherein the delivery catheter comprises aninfusion lumen, a return lumen, an outflow aperture through whichinfused substances may flow out of the infusion lumen and a flowdiverter, said flow diverter that is alternately deployable in i) aninfusion position whereby substances infused through the infusion lumenwill flow out of the outflow aperture and ii) a recirculation positionwhereby fluid infused through the infusion lumen will be recirculatedback through the return lumen.
 161. A system according to claim 148wherein the delivery catheter comprises a pressure increasing outflowopening configured to cause an increase the pressure of fluids that areinjected through the delivery catheter lumen and out of said pressureincreasing outflow opening.
 162. A system according to claim 161 whereinsaid pressure increasing outflow opening is formed in the side wall ofthe delivery catheter.
 163. A system according to claim 162 wherein aplurality of pressure increasing outflow openings are formed in the sidewall of the delivery catheter.
 164. A system according to claim 138wherein the delivery catheter further comprises an anchoring member foranchoring the catheter in a substantially fixed position within thepatient's body.
 165. A system according to claim 164 wherein theanchoring member is selected from the group of anchoring membersconsisting of: a hook; a barb; a permeable surface into which tissue maygrow; an adhesive; and, combinations thereof.
 166. A system according toclaim 138 wherein the delivery catheter further comprises a backflowdeterrent member for blocking backflow of substances that have beeninjected through the delivery catheter.
 167. A system according to claim166 wherein said backflow deterrent member comprises a backflow barrierrib formed on the delivery catheter.
 168. A system according to claim167 wherein said backflow barrier comprises an inflatable balloon on thedelivery catheter.
 169. A system according to claim 167 wherein saidbackflow barrier comprises a raised projection formed on the exterior ofthe delivery catheter.
 170. A system according to claim 169 wherein theraised projection comprises an annular rib formed about the outersurface of the delivery catheter
 171. A system according to claim 167wherein the backflow deterrent member comprises a sealant that isimplanted prior to or concurrently with removal of the delivery catheterso as to prevent the injected substance from bacflowing through thetract from which the delivery catheter is removed.
 172. A systemaccording to claim 171 wherein the sealant comprises a quantity of aflowable sealant injected into the tract upon removal of the deliverycatheter.
 173. A system according to claim 171 wherein the sealantcomprises a detachable sealing member.
 174. A system according to claim173 wherein the detachable sealing member is formed of biodegradablematerial.
 175. A system according to claim 173 wherein the detachablesealing member comprises a collagen sponge.
 176. A system according toclaim 173 wherein the detachable sealing member comprises a hydrogelsponge.
 177. A system according to claim 138 wherein at least a portionof the delivery catheter is coated with an adhesive.
 178. A systemaccording to claim 138 wherein an anti-microbial substance is disposedon at least a portion of the delivery catheter.
 179. A system accordingto claim 138 wherein an anti-coagulant substance is disposed on at leasta portion of the delivery catheter.
 180. A system according to claim 1further comprising apparatus for creating a pocket within tissueadjacent to the delivery catheter such that when a substance orapparatus is introduced through the delivery catheter it will bereceived within said pocket.
 181. A system according to claim 180wherein the apparatus for creating a pocket comprises an energy emittingmember that emits energy into adjacent tissue to create said pocket.182. A system according to claim 181 wherein the energy emittingapparatus comprises a radiofrequency electrode.
 183. A system accordingto claim 182 wherein the energy emitting apparatus comprises a laser.184. A system according to claim 181 wherein the apparatus for creatinga pocket comprises a nozzle through which a stream of fluid may beinjected to create the pocket in adjacent tissue.
 185. A systemaccording to claim 181 wherein the apparatus for creating a pocketcomprises an expandable cage which, when expanded, creates said pocket.186. A system according to claim 138 further in combination with aninfusion apparatus for infusing a substance through the deliverycatheter.
 187. A system according to claim 186 wherein said infusionapparatus is a syringe.
 188. A system according to claim 186 whereinsaid infusion apparatus is a pump.
 189. A system according to claim 186wherein said infusion apparatus is a reservoir positioned for gravitydrainage of the substance through the delivery catheter.
 190. A systemaccording to claim 186 wherein said infusion apparatus further comprisesa quantity of a substance for infusion through the delivery catheter.191. A system according to claim 190 wherein the substance is a drug.192. A system according to claim 191 wherein the drug is selected fromthe group consisting of: thrombolytics, platelet inhibitors,anti-restenotic agents, beta adrenergic blockers, ion channelantagonists, positive or negative ionotropic agents, anti-arrhythmicsand combinations thereof.
 193. A system according to claim 190 whereinthe substance is a protein.
 194. A system according to claim 190 whereinthe substance is an angiogenic substance.
 195. A system according toclaim 194 wherein the angiogenic substance is selected from the groupconsisting of vascular endothelial growth factor (VEGF), fibroblastgrowth factors (FGF), epidermal growth factor (EGF), platelet-derivedgrowth factor (PDGF), hepatocyte growth factor (HGF) or scatter factor,heparin combined with an adenosine receptor agonist, and combinationsthereof.
 196. A system according to claim 190 wherein the substancecomprises cells.
 197. A system according to claim 196 wherein thesubstance comprises progenator cells for a type of cell that is desiredto be formed at the target site.
 198. A system according to claim 196wherein said substance comprises myoblasts to form cardiac muscle cells.199. A system according to claim 196 wherein said cells are selectedfrom the group consisting of stem cells, progenator cells, myoblasts,myocytes, secretory cells, pancreatic islet cells, dopamine secretingcells, endothelial cells, hepatocytes, cloned cells, cells grown in cellculture, genetically modified cells, and combinations thereof.
 200. Asystem according to claim 190 wherein the substance is a gene.
 201. Asystem according to claim 190 wherein the substance comprises a gene anda vector for facilitating entry of the gene into locations within cellsat which the gene will have a desired effect on the cells.
 202. A systemaccording to claim 201 wherein the vector is a virus.